Provider Demographics
NPI:1053791301
Name:KAREN J DELANEY DDS
Entity type:Organization
Organization Name:KAREN J DELANEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-937-1764
Mailing Address - Street 1:399 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1859
Mailing Address - Country:US
Mailing Address - Phone:207-454-2350
Mailing Address - Fax:207-454-2897
Practice Address - Street 1:399 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1859
Practice Address - Country:US
Practice Address - Phone:207-454-2350
Practice Address - Fax:207-454-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4422302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization